Health Insurance & Renters Insurance Unit 6 Insurance Health Insurance & Renters Insurance

10 things you should know about Health Insurance Health Insurance: The Basics 10 things you should know about Health Insurance Insurance costs a lot but having none costs more If your employer offers insurance, grab it Comparing plans is tough but necessary The lowest premium isn’t always the cheapest plan Even good coverage can have big loopholes You’ll pay more for freedom You can check out networks before signing up You can keep your insurance if you lose your job Working couples have more to think about Tax breaks can help Top ten provided by

Health Insurance: The Basics At some point in your life you will probably need expensive medical care Health Insurance, like other kinds of insurance, protects you against significant financial loss It ensures you can afford medical help when you need it Health Insurance can help keep you healthy by detecting and treating dangerous medical conditions before they become serious

Health Insurance: The Basics It is important that you understand health insurance in order to protect yourself and your family Not long ago, individuals paid for medical expenses out of their pocket directly to the provider As the costs of healthcare continued to rise it was apparent that the public needed a way to help pay for the services

Health Insurance: The Basics Law of Large Numbers Health insurance companies, as with other types of insurance companies, protect themselves against financial loss by spreading the risk of costly claims among many customers over many years Pre-existing Conditions The more likely that people need health insurance, the more likely they are to seek it An insurer may refuse to cover treatment if the condition existed prior to enrolling in a health insurance plan

Two Basic Plans: Group Plans and Individual Plans Health Insurance: The Basics Two Basic Plans: Group Plans and Individual Plans Group Plans A group buys insurance for everyone in the group Most Americans fall into some type of group plan Employer, professional, religious, or other organizations can purchase group plans for their members In most cases, group insurance is provided by an employer as a benefit to its employees

Group Plans (continued) Health Insurance: The Basics Group Plans (continued) Advantages: Generally less expensive Everyone who belongs to the group can enroll even if pre-existing conditions exist Disadvantages: Options are limited depending on what the plan sponsor chooses The plan sponsor can discontinue the insurance at any time as long as everyone in the plan is dropped

Health Insurance: The Basics Individual Plans People who are self-employed, or whose company does not offer health insurance as a benefit, can buy health insurance directly from an insurance company Advantages: You can have the policy written for your needs Discounts can be offered for healthier people Disadvantages: Usually more expensive If a pre-existing condition exists, it will be very expensive to cover

Health Insurance: The Basics The Bottom Line Young people who are relatively healthy often do not see the need for health insurance Unless an illness is life-threatening, a health-care provider can refuse to treat you If a young person had a catastrophic illness or accident the medical bills could easily top $50,000 No matter what your economic or health status is you can usually find a plan that will at least cover some of your needs including a catastrophic accident or illness

Government-Provided Health Insurance A healthy population is a benefit to society The government provides health insurance for citizens it deems most in need “Entitlement Programs” Medicaid Medicare

Medicaid Became law in 1963 under the Social Security Act Provides medical assistance for eligible individuals and families with low incomes and resources Varies widely from state to state because each state establishes their own guidelines

Medicare The nation’s largest health insurance program Covers 39 million Americans The largest group covered by Medicare is people over the age 65 Also provides care for people with disabilities

Medicare Two types of Plans Type A: Covers a percentage of hospital bills Free to anyone who has worked 10 years in Medicare-covered employment Type B: Covers non-hospital expenses Charges a small monthly premium You must pay a deductible and a co-payment for each

Types of Health Plans The practice of medicine is complicated and expensive Medical insurance often covers routine care, such as annual physicals, and most major medical expenses Every health plan is different, but most fall into categories

Types of Health Plans Health insurance plans are binding, legal contracts between the insurer and the insured Health insurance plans, like other kinds of insurance, include premiums and deductibles Unlike other types of insurance, most health insurance plans have a co-payment A co-payment is the portion of a claim or medical expense that a member of a health plan must pay out-of-pocket. Usually this is a fixed amount, such as $5 or $10, for each visit.

Fee-for-Service Plans (FFS) You can go to any physician, hospital, lab, or pharmacy Usually works on an 80-20 ratio Insurer pays 80% Insured pays 20% (until maximum out-of-pocket is met) The biggest advantage is plan flexibility The biggest disadvantage is the cost More paperwork involved than in other plans

Managed Care Plans Members have a network of healthcare providers they can go to Physicians and other providers agree to charge reduced fees for members because they are guaranteed patients and they know they will be paid for their services

Health Maintenance Organization (HMO) Managed Care Plans Health Maintenance Organization (HMO) The most common type of managed care plan Primary care physician (PCP) serves as gatekeeper Advantages: Lower Cost Most include preventative and health improvement services Less paperwork Disadvantage: Lack of flexibility

Preferred Provider Organization (PPO) Managed Care Plans Preferred Provider Organization (PPO) Combine the features of HMOs and fee-for-service plans Members can visit any healthcare provider in their network with a co-payment Referrals are not required from PCP as long as provider is in network Tend to cost more than HMO plans but less than FFS plans

Matching a Health Plan to your Needs Group Plans Does your employer or group offer a plan? Do you have a choice of plans? How much can you tailor each plan?

Matching a Health Plan to your Needs Group Plans Evaluate your medical needs List the people in your household and what their medical needs are Are there any chronic conditions that would affect coverage?

Types of Health Plans Group Plans Common coverage types: Hospitalization Rehabilitation facility care Hospital outpatient services Physical therapy Physician hospital visits Speech therapy Office visits Home health care Skilled nursing services Hospice care Diagnostic tests Maternity care Prescription drugs Chiropractic care Mental health care Preventive care and checkups Drug and alcohol abuse treatment Well baby care Contraceptives Dental care Fertility treatments Vision care

Matching a Health Plan to your Needs Individual Plans You can customize your plan to match your personal needs Your state department of insurance will have a list of insurers in your area Get at least three quotes for each type of plan You will have to provide evidence of insurability

Matching a Health Plan to your Needs Individual Plans Underwriting Factors: Age Health Occupation Habits Lifestyle The higher the risk factors that an insurer has the higher the premium will be